INFORMATION FOR 404 PERMIT APPLICATIONS
COUNTY:	ROUTE:	JOB NO.:

Amount and type of excavation and material which will be used in streams, lakes and wetlands BELOW THE CORPS OF ENGINEERS' ORDINARY HIGHWATER LINE (OHL) elevation (for larger structures this should be determined during the bridge survey, for other stream crossings, request OHL elevations be taken during ground survey of smaller culverts). OHL by the Corps definition is the area on the stream bank where the vegetation ends.

1.	OHL elevation:

Streambed elevation:

1.	Permanent berms and spill fills (in wetlands/streams below OHL)

a.	Earth fill sq. ft. and CY

b.	(1) Rock blanket sq. ft. and CY

(2) Linear ft. of rock blanket along the stream bank (excluding bridge width):

right descending bank = ft.; left descending bank = ft.

c.	Other fills?

2.	Bridge/Structures

Length of structure ft. and Width of structure ft.

Type of structure

No. of piles/bents/etc. in stream

Area of disturbance for piles/bents/etc. below OHL sq. ft. and CY

(Define what is included in this amount)

3.	Culverts/Pipes (no channel realignment)

a.	Linear feet of existing channel (inlet to outlet) ft.

b.	Average width of existing channel (inlet to outlet) ft.

c.	Culvert length ft.

d.	Culvert extension ft.

e.	Riprap length at outlet/inlet ft.

f.	Type of culvert(s)

4.	Bridge or culvert with channel realignment( beyond structure)

a. Existing channel length of section to be modified ft.

b. Average channel width in section to be modified ft.

c. Realigned section: length = ft., width = ft.

d. Realigned section width ft.

5.	Temporary fills (Best Estimate; in wetlands, streams below OHL)

a.	Earth fill sq. ft. and CY

Location of temporary fills:

Work pads? sq. ft. CY

Temporary crossing? sq. ft. CY

Temporary bypass? sq. ft. CY

Cofferdams? sq. ft. CY

Other?

d.	Pipe/Culvert - Number: Size: Length: ft.

(Opening shall be sufficient to handle normal flow, no ponding/pooling of water.)

6.	Channel cleanout - excavation below OHL:

a. linear ft. of cleanout upstream of structure

b. linear ft. cleanout downstream of structure

NOTES TO DESIGNER:

1.	An 8½" x 11" copy of the plan and profile should be sent with the above information for the file. The Corps of Engineers Ordinary High Water line (OHL) elevation should be printed and shown on the profile view along with the Design High Water typically shown. If the roadway design drawings do not include all of the detailed information requested above, include 11" x 17" copy of the bridge from the Design Layout prepared by the bridge division. The plan and profile sheets can be provided electronically or hard copy.

2.	An 8½" x 11" copy of the plan sheet of the temporary crossing or bypass should also be sent with the above information. This can be provided hard copy or electronically.

3.	A copy of USGS 7.5' topographic map with project alignment and end points marked should also be sent with the above information.

4.	Earth fill may be used for temporary fill only if capped with Class C material.

5.	In lieu of submitting multiple copies of this form, the district may submit a single table with information requested on this form for each crossing of a wetland, stream (shown as blue line on USGS), or other water body considered to be a water of the United States (all lakes and some ponds - consult with the environmental section in the Preliminary Studies Divisions to make this determination).